Journal of Perinatology最新文献

Objective: To evaluate the pain intensity in preterm infants during 48 h post retinopathy of prematurity (ROP) screening by binocular fundoscopy.

Design: Prospective cohort study.

Settings: Level-III-NICU in India.

Participants: 83 Neonates undergoing first ROP screening.

Main outcome measures: Pain assessment using the premature infant pain profile-revised (PIPP-R) score at baseline and 5 min, 30 min, 6 h, 24 h, and 48 h post-procedure.

Results: The mean gestation and birth weight was 29.8 (2.3) weeks and 1256 (344)g respectively. The median (IQR) PIPP-R score at baseline was 0 which significantly increased to 10.5 (8,12.5) 5 min (immediately) after the procedure. At 30 min and 6 h, scores were 7 (5,8) and 4.5 (3,5.5) respectively. After 24 h and 48 h, it decreased to 3 (0,5) and 0 (0,4.5) respectively. Nearly 59% (95%CI:40%-83%) of neonates had severe pain (PIPP-R score > 12) immediately after procedure.

Conclusion: A majority of neonates experience severe pain immediately after ROP screening, and mild-moderate pain continues for 6 h. Hence, an additional pharmacological agent should be considered for reducing neonatal pain.

Objective: To examine the relationship between gestational COVID-19 and perinatal-neonatal outcomes.

Study design: Prospective cohort study. Neonates born at Hospital del Mar (Barcelona) between 2020 and 2022 were classified into two cohorts according to their mother's COVID-19 status during pregnancy. Prenatal and postnatal variables were compared between the COVID-19 and the control cohort, and depending on timing and severity of maternal infection.

Results: We included 2701 neonates and observed higher rates of respiratory distress (5.7% vs 3.3%, p = 0.044) and pathological jaundice (7.7% vs 4.1%, p = 0.007) in the COVID-19 cohort, without differences between trimesters. We did not find statistically significant differences in other perinatal outcomes. The logistic regression analyses showed that maternal COVID-19 was not a risk factor for prematurity (OR:1.23;CI:0.75-2.03; p = 0.407).

Conclusions: Infants born to mothers with COVID-19 during pregnancy in our hospital showed higher rates of respiratory distress and pathological jaundice, without increased rates of prematurity or other morbidities.

Objective: Maternal presence in the Neonatal Intensive Care (NICU) supports infant and maternal health, yet mothers face visitation challenges. Based on intersectionality theory, we hypothesized that mothers of Black infants with lower socioeconomic status (SES) living further from the hospital would demonstrate the lowest rates of maternal presence.

Study design: We extracted infant race, Medicaid status, and maternal home address from 238 infant medical charts. The primary outcome was rate of maternal presence. Generalized linear modeling and binomial regression were employed for analysis.

Results: Medicaid status was the strongest single predictor of lower rates of maternal presence. Having lower SES was associated with lower rates of maternal presence in mothers of white infants, and living at a distance from the hospital was associated with lower maternal presence in mothers of higher SES.

Conclusions: Interventions to support maternal presence in the NICU should address resource-related challenges experienced by mothers of lower SES.

Disease categories traditionally reflect a historical clustering of clinical phenotypes based on biologic and nonbiologic features. Multiomics approaches have striven to identify signatures to develop individualized categorizations through tests and/or therapies for 'personalized' medicine. Precision health classifies clinical syndromes into endotype clusters based on novel technological advancements, which can reveal insights into the etiologies of phenotypical syndromes. A new taxonomy of preterm birth should be considered in this context, as not all preterm infants of similar gestational ages are the same because most have different biologic vulnerabilities and hence different health trajectories. Even the choice of interventions may affect observed clinical conditions. Thus, a new taxonomy of prematurity would help to advance the field of neonatology, but also obstetrics and perinatology by adopting anticipatory and more targeted approaches to the care of preterm infants with the intent of preventing and treating some of the most common newborn pathologic conditions.

When a baby is born premature, a landscape of potential problems replaces an imagined future. Outcomes become the measures of success. Researchers are recognizing that we need the direct input of parents to select meaningful outcomes. In this article, we describe how researchers and clinicians in neonatology have historically defined outcomes and the limitations of these methods. We chart the integration of stakeholders-patients and parents-into outcomes selection. 'Parent-important outcomes' are those deemed most important by parents, as the voices of their children. We outline a path toward determining parent-important outcomes in neonatology through mixed methods research. We conclude by suggesting how parent-important outcomes can be integrated into neonatal follow up research and clinical trial design. Ultimately, all researchers of prematurity aim in some way to improve outcomes that parents and patients care about. We hope this article will remind us of this beacon.

Objectives: Characterize the relationship between infant outcomes and prenatal homelessness, food insecurity and unemployment.

Study design: California live births between 22- and 44-weeks' gestation comprised 6,089,327 pregnancies (2007-2020). Data were collected from linked Vital Statistics and hospital discharge records. Prenatal homelessness, food insecurity, and unemployment were classified as health-related social needs (HRSN) using International Classification of Disease codes in delivery records. Risk ratios for preterm birth, low birthweight, small for gestational age, neonatal intensive care unit admission, emergency department admission, rehospitalization, and death were estimated using log-linear Poisson regression adjusted for birthing person race, payer, and education.

Results: 65.7 per 100,000 births had HRSN. These infants had a higher risk of preterm birth (aRR 2.7), low birthweight (aRR 2.7), SGA (aRR 1.5), NICU admission (aRR 3.5), and death (aRR 3.0).

Conclusions: HRSN increase the risk of infant morbidity and mortality but remain underreported in administrative records, making definitive conclusions difficult.